Fermentable sugars, pH and titratable acidity of paediatric over-the-counter oral medicines marketed in Belgium

Abstract Paediatric oral medicines are often formulated to improve palatability and stability using fermentable sugars and organic acids. Frequent or prolonged use of these excipients may contribute to caries risk and erosive tooth wear. An in vitro assessment of 20 paediatric oral medicines available in Belgian community pharmacies (10 syrups, 7 granules, and 3 effervescent tablets) was conducted. Fructose, glucose, and sucrose were quantified by HPLC with refractive index detection. pH and titratable acidity were also measured. Fermentable sugars were detected in 7 of the 20 products (6 syrups and 1 granule), with concentrations reaching 638.47 mg/mL in syrups and 879.97 mg/dose in one granule formulation. At the maximum labelled daily dose, free sugar intake from individual products ranged from 0.19 to 14.9 g/day. pH ranged from 2.37 to 9.26, and 13 of the 20 formulations had a pH below 5.5. Titratable acidity varied widely (5.83-2333.30 µL; n = 16), with the highest values observed in effervescent tablets. Plotting pH against estimated maximum daily exposure to quantified fermentable sugars identified products combining quantifiable sugars with low pH, as well as sugar-free products that remained acidic and/or highly titratable.